Mouratidou Christina, Tsakiri Kalliopi, Dourliou Vasiliki, Marneri Alexandra, Stougianni Maria, Pavlidis Efstathios
Department of Adult Intensive Care Unit, Ippokrateio General Hospital, 54642 Thessaloniki, Greece.
Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Ippokrateio General Hospital, 54642 Thessaloniki, Greece.
Diagnostics (Basel). 2025 May 31;15(11):1402. doi: 10.3390/diagnostics15111402.
Candidemia is a significant cause of morbidity and mortality among critically ill patients. Early-onset candidemia is characterized by occurring within the first seven days after admission to the Intensive Care Unit and presents several important challenges regarding its management. Risk factors may vary among patients with early- and late-onset infection, while clinical manifestations are generally non-specific and covered by the underlying disease and co-morbidities. Diagnosis and appropriate therapy are frequently delayed, with a high risk of progression to invasive, deep-seated infections, leading to rapid clinical deterioration. Management strategies to optimize the approach for patients with early-onset candidemia include the use of both conventional and novel diagnostic techniques, the initiation of appropriate antifungal therapy, administration of an adequate dose, daily evaluation of clinical response, de-escalation treatment whenever possible, and early discontinuation. Incorporating an antifungal stewardship program in clinical practice is essential in order to achieve the best clinical outcomes. Based on a review and analysis of the available literature, this article provides a thorough update on the risk factors, clinical characteristics, diagnostic methods, and management of early-onset candidemia in adult critically ill patients.
念珠菌血症是重症患者发病和死亡的重要原因。早发性念珠菌血症的特点是在入住重症监护病房后的头七天内发生，其管理面临若干重要挑战。早发性和晚发性感染患者的危险因素可能有所不同，而临床表现通常无特异性，被基础疾病和合并症所掩盖。诊断和适当治疗常常延迟，进展为侵袭性深部感染的风险很高，导致临床迅速恶化。优化早发性念珠菌血症患者治疗方法的管理策略包括使用传统和新型诊断技术、启动适当的抗真菌治疗、给予足够剂量、每日评估临床反应、尽可能进行降阶梯治疗以及尽早停药。在临床实践中纳入抗真菌管理计划对于实现最佳临床结果至关重要。基于对现有文献的综述和分析，本文全面更新了成人重症患者早发性念珠菌血症的危险因素、临床特征、诊断方法和管理。
